Fever

Fever

Department of Physical Diagnostics 1st Teaching Hospital Zhengzhou University

Normal Temperature  Axillary

T: 36.0 ℃~37.0 ℃

 Oral

T: 36.3 ℃~37.2 ℃

 Anal

T: 36.5 ℃~37.7 ℃

T fluctuates within 1 ℃ in 24 hours

Grade of Fever  Slight:

37.3-38℃

 Moderate:

38.1-39℃

 Hyperpyrexia:

39.1-41℃

 Ultrahyperpyrexia:

>41℃

Phases of Fever  Rising

phase

T41  Peak phase 40 39 38  Falling phase 37 36

Cour se 1 2 3 4 5 6 7 8 9 10 11 12

Fever Types 



Continuous fever: T varies within 1 ℃ in every 24 hours. Seen in lobar pneumonia, typhoid fever.

Remittent fever: T fluctuates over 2 ℃ every 24 hours. Seen in septicemia, supprative inflammation.    

 Fever Types 



Intermittent fever: sudden rises and falls. High fever may last several hours. Seen in malaria, acute pyelonephritis. Recurrent fever: sudden rises and falls. High fever may last several days. Seen in recurrent fever, Hodgkin’s disease.

Fever Types  Undulant

fever: slow rises and falls. High fever may last several days. Seen in brucellosis.  Irregular fever: seen in tuberculosis, rheumatic fever, pleuritis, etc.

Causes of Fever  Infective

fever:

– Account for 50%-60% • Bacteria: 43% • Virus: 6% • Rickettsia • Fungi

Non-infective Fever  Pyrogen

reaction

– Allergic reaction – Absorption fever

 Dysfunction

– – – –

of thermostat

Centris fever Thermoneurosis Increased thermogenesis Decreased thermolysis

Concomitant Symptoms  Rigor:

– Infective: pneumonia, septicemia, cholecystitis, pyelonephritis, malaria – Non-infective: drug fever, transfusion reaction

Lymphadenectasis  Regional

infection, tuberculosis  Leukemia, lymphoma

Hepatosplenomegaly • Hepatitis, malaria • Leukemia, connective tissue diseases

Skin Lesions  Infection:

measles, scarlet fever  Immunologic reaction: rheumatic fever

Coma:

Cerebral diseases: cerebral hemorrhage, heat stroke

Edema Definition:

excessive

fluid accumulation in tissue space

 Vein

Artery

Capillary

Mechanisms of Edema General

localized

Intra-capillary pressure↑

Vascular permeability ↑

Water and sodium retention

Venous embolism

Hydrostatic pressure ↑

Vena cava depression

Colloid osmotic pressure ↓

Lymphatic obstruction

Vascular permeability ↑

Degree of Edema  Pitting

edema  Non-pitting edema ( due “glue”

to the

— protein )

– Increased vascular permibility: acute glomerulonephritis – Obstruction of lymphatic return: myxedema, elephantiasis.

Types of Edema  Cardiac

edema  Nephritic edema  Hepatic edema  Malnutritional edema  Myxedema  Premenstrual edema  Drug-induced edema  Idiopathic edema

Cardiac Edema  Mechanism:

right heart failure, water and sodium retention  Clinical features: – pendulous edema – the site of edema is associated with position – Accompanied by signs of congestion of systemic circulation such as distention of jugular vein, liver enlargement.

Nephritic Edema  Mechanisms:

retention of water and sodium, increased permeability, and decreased colloid osmotic pressure induced by renal diseases  Clinical features: edema originates from face, esp. the eyelids, progressing downward to the whole body. Accompanied by urine abnormalities, high blood pressure, and renal injury.

Hepatic Edema  Mechanism:

hypoproteinemia, retention of water and sodium, and portal vein hypertension induced by liver cirrhosis.

 Clinical

– – – –

features:

Pendulous edema Accompanied by ascites Liver injury Collateral circulation caused by portal hypertension

Malnutritional Edema  Mechanism:

hypoproteinemia, decreased colloid osmotic pressure.  Clinical

features:

– pendulous edema – Preceded by weight loss 

Diarrhea

Definition: The

presence of stool liquidity (instead of formed or soft stool) and an increase in daily stool weight ( the upper normal limit of which is 200 grams in industrialized societies) . Acute diarrhea and chronic diarrhea: – 2 months is the boundary

Pathogenesis of Diarrhea         Secretory Osmotic

diarrhea

diarrhea

Malabsorptional

diarrhea

Hyperperistaltic

diarrhea

Causes of Diarrhea      Digestive

– – – –

Intestinal tract diseases Hypohydrochloria Diseases of the pancreas Diseases of the liver and the gallbladder

 General

– – – –

system diseases

diseases

Disturbance of endocrine and metabolism Side effect of the drugs Disturbance of the nervous system Allergic diarrhea

Diarrhea Caused by Enteritis         Paste-like

or water-like stool  Excessive loss of water may result in dehydration  Pain around the unbilicus and can’t be relieved by defecation  Acute onset, usually caused by unsanitary meal  Abrupt onset of painless watery diarrhea suggests cholera

Diarrhea Caused by colonitis  Mucus,

pus, and blood appear in the stool  Frequent defecation (10-15/d or more)  Lower abdominal pain, relievable by defecation  Tenesmus suggests the lesion is at the end of the colon  Long-lasting diarrhea, weight loss without fever: carcinoma?